Expat insurance and health insurance in the Turks and Caicos Islands

The health system of the Turks and Caicos Islands rests on a national health insurance scheme, the National Health Insurance Plan (NHIP), run by the National Health Insurance Board (NHIB), a body created in 2009 by the National Health Insurance Ordinance. According to the NHIB FAQ, registration is compulsory: you may keep private insurance, for example to access private doctors, but you must also join the NHIP. Employees are registered by their employer, who withholds the employee share and pays it to the NHIB by the 14th of the month at the latest; self-employed workers, registered unemployed people, retirees, students, dependants and voluntary contributors come under separate categories. People in an irregular situation cannot register, and tourists are not eligible.

The Ministry of Health and Human Services sets policy, regulates and licenses facilities and professionals, and coordinates the response to emergencies. The territory's two hospitals are the Cheshire Hall Medical Centre in Providenciales and the Cockburn Town Medical Centre in Grand Turk; public primary care clinics exist in North Caicos, South Caicos, Salt Cay and Middle Caicos. The emergency medical service (EMS) provides medical transport 24 hours a day, including medical evacuation, and the emergency number is 911. When care is not available on the spot, the NHIP arranges a referral abroad: InterHealth Canada first assesses whether local facilities can provide the treatment, then the NHIP's medical director checks that the treatment is covered; the NHIP then pays the foreign provider and the patient pays the uncovered share.

No France Diplomatie travel advice page was found for this territory at the date of consultation: an assistance contract with medical evacuation therefore remains to be considered, all the more so as the NHIP limits cover abroad to emergencies and essential care not available in the Turks and Caicos Islands.

• Tourist stay: the Ministry of Immigration's visitor visa page states that France is on the list of countries whose nationals do not need a visa. The length of stay granted on arrival is not specified on this page: it should be confirmed with the Ministry (infobordercontrol@gov.tc) before departure, as should the passport validity conditions.
• Work: a work permit is necessary; it is applied for by the employer (the self-employed worker or freelancer may submit their own application) and can last up to 5 years for a skilled job and 3 years for an unskilled job. A certificate of good health and a criminal record are requested.
• Registration with the NHIP and the NIB: the employer declares the employee to both bodies; proof of up-to-date contributions to the NHIP and the NIB is requested for work permit renewals. Anyone aged 16 to 65 carrying on paid activity must be registered with the NIB.
• Resident without a job: registration with the NHIP remains compulsory for residents in a regular situation, in the voluntary contributors category when no other fits; the amounts can be read from the NHIB.
• Student: no European Health Insurance Card, as the territory is not in the European Union. The NHIP provides a “student” category (student visa required for a foreign student); a student insurance remains to be compared depending on the length of stay.
• Seconded employee : stays on the French scheme, according to CLEISS, for three years renewable once, with reimbursement up to what the French scheme provides on paid invoices (form S 3125c). Membership of the Caisse des Français de l'Étranger (CFE) is an optional top-up.
• Retiree: CLEISS points to local institutions, voluntary membership of the CFE or private insurance; no S1 form exists, as the territory is not in the European Union.

The sources consulted mention no individual fine for a resident not registered with the NHIP, but the NHIB FAQ provides that late registration may lead to a penalty and the exclusion of certain conditions, without specifying the duration, and the NHIB applies a 3% monthly surcharge for late payment of contributions.

The Turks and Caicos Islands are not in the European Union, and CLEISS lists them neither among the States linked to France by a social security agreement nor among the territories covered by the European regulations: for a temporary stay, they fall under the category “other countries or situations not covered”. The CLEISS list of foreign schemes has no entry for this territory and the page on the United Kingdom does not mention it. Without an agreement, no cover is arranged between the funds.

• Temporary stay: CLEISS indicates that reimbursement on return to France of unforeseen care is a possibility and not an obligation, that medical repatriation is not covered by health insurance, and that it is prudent to take out travel insurance suited to the real cost of care.
• Secondment: the employee remains affiliated to the French scheme, three years renewable once; contributions are paid in France as if they worked there, but they may also have to pay those of the host country. Care is covered up to what they would have received in France (form S 3125c with paid invoices).
• Expatriation: the employee comes under the local scheme and leaves the French scheme; they can join the CFE voluntarily. Without an agreement, France does not take local periods into account when calculating the French pension.
• Retiree: CLEISS recommends checking local cover, choosing the CFE or private insurance, and points out that a retiree who is not tax resident pays neither CSG, nor CRDS, nor Casa.
• Taxation: the BOFiP list of tax treaties in force does not include the Turks and Caicos Islands. An agreement in the form of an exchange of letters on the exchange of tax information, signed in Paris on 18 September 2009 and in Waterloo on 5 October 2009, has been in force since 14 July 2011 (decree no. 2011-1834 of 7 December 2011): it organises cooperation between administrations without allocating taxing rights. Tax residence remains defined by article 4 B of the French General Tax Code (home or main place of stay, professional activity, centre of economic interests), a single criterion being enough. The local revenue department lists neither income tax nor payroll tax among the taxes it administers.

1. Before departure: notify French agencies of your departure (CPAM, CAF, France Travail, pension funds) and choose your cover according to your status.
2. Check with the Ministry of Immigration (infobordercontrol@gov.tc) the length of stay granted on arrival and the passport validity required.
3. Employee: have the employer submit the work permit application, with certificate of good health, criminal record and contract; the Ministry announces 15 days of processing without prior labour clearance and 25 days with.
4. Seconded employee: request attachment to the French scheme from your employer and your fund; keep paid invoices for form S 3125c.
5. Resident without an employer: enquire with the Ministry of Immigration about the residence route, then register with the NHIB.
6. Retiree: prepare health cover (CFE or private insurance) and the residence route before departure, noting that no “retiree” category is described in the sources consulted.
7. Family: arrange insurance for your spouse and children (NHIP “dependants” category) and the residence endorsements needed.
8. Register on the roll of French nationals living abroad on service-public, with the Consulate General of France in Miami; registration is valid for five years.
9. Hurricane season: save the numbers of the Department of Disaster Management and Emergencies (DDME) and prepare a family plan and an emergency kit.